abstract details

The summaries are free for public use. ARTHROS will continue to add and archive summaries of articles deemed relevant to ARTHROS by our Faculty.

Reasons for b/tsDMARD cessation and persistence of second line treatment in a large real world rheumatoid arthritis dataset

Author

Youssef P1, Marcal B1, Button P1, Truman M1, Bird P1, Dip G1, Griffiths H1, Roberts L1, Tymms K1, Littlejohn G1. J Rheumatol. 2019 Dec 1. pii: jrheum.190535. doi: 10.3899/jrheum.190535. [Epub ahead of print]

Author Information

1 From Royal Prince Alfred Hospital, Camperdown, NSW, Australia; University of Sydney, Sydney, NSW, Australia Roche Products Pty Limited, Sydney, NSW, Australia; OzBiostat Pty. Ltd., Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia; Barwon Rheumatology Service, Geelong, VIC, Australia; Monash Rheumatology, Clayton, VIC, Australia; Canberra Rheumatology, Canberra, ACT, Australia; Monash University, Clayton, VIC, Australia. Funding: The study was supported by Roche Products Pty Limited (Australia). Author Conflict of Interest: PY reports honoraria and consultancy fees from Roche Products, Pty. Limited, AbbVie, Novartis and Eli Lilly, all outside the submitted work. BM is an employee of Roche Products Pty. Limited and reports stock ownership at Roche. PButton was an employee of Roche Products Pty. Limited until December 2017 and then worked as a consultant statistician during the conduct of the study. MT was an employee of Roche Products Pty. Limited until December 2017 and then worked as a consultant statistician during the conduct of the study; and he reports stock ownership at Roche. PBird does not have anything to declare. HG reports consultancy fees from Roche Products, Pty. Limited, outside the submitted work. LR does not have anything to declare. KT reports personal fees and non-financial support from Roche Products, Pty. Limited, non-financial support from Bristol-Myers Squibb, non-financial support from UCB, outside the submitted work. GL reports consultancy fees from Roche Products, Pty. Limited, Janssen, and AbbVie; and honoraria fees from Sanofi, all outside the submitted work. Address correspondence to Professor Peter Youssef, Royal Prince Alfred Hospital, Camperdown, NSW, Australia 2050, University of Sydney. Email: pyoussef@med.usyd.edu.au.

Abstract

OBJECTIVE: 

To provide real world evidence about the reasons why Australian rheumatologists cease biologic (b) and targeted synthetic (ts) disease-modifying anti-rheumatic drugs (DMARDs) when treating rheumatoid arthritis (RA) patients and to assess primary failure rate for first-line treatment and the persistence on second-line treatments in patients who stopped first-line tumor necrosis factor inhibitors (TNFi).

METHODS: 

This is a multi-centre retrospective, non-interventional study of RA patients enrolled in the Australian Optimising Patient outcome in Australian RheumatoLogy (OPAL) dataset with a start date of b/tsDMARDs between 1 August 2010 and 30 June 2017. Primary failure was defined as stopping treatment within 6 months of treatment initiation.

RESULTS: 

Data from 7740 patients were analysed; 6914 patients received first-line b/tsDMARDs. First-line treatment was stopped in 3383(49%) patients; 1263(37%) were classified primary failures. The most common reason was "lack of efficacy" (947/2656; 36%). Of the patients who stopped first-line TNFi, 43% (1111/2560 patients) received second line TNFi, which resulted in the shortest median time to stopping second-line treatment (11 months, 95% CI 9-12) compared with non-TNFi. The longest second-line median treatment duration after first line TNFi was for patients receiving rituximab (39 months; 95% CI 27-74).

CONCLUSION: 

A large proportion of patients who stopped first-line TNFi therapy received another TNFi despite evidence for longer treatment persistence on second-line b/tsDMARDs with a different mode of action. Lack of efficacy was recorded as the most common reason for making a switch in first-line treatment of RA patients.